重度子(癎)前期191例严重并发症的监测

目的 探讨重度子痫前期各种严重并发症的发生与临床指标的关系,寻求针对重度子痫前期严重并发症更好的监测手段,以期提供对重度子痫前期严重并发症及早干预措施和有效的临床监控方法.方法 对北京大学第三医院1999-01-2005-01 收治的191例重度子痫前期孕妇的前瞻性观察资料进行分析总结.将重度子痫前期起病时间以34孕周为界分为早发型（100例）和晚发型（91例）重度子痫前期两组.将一般临床资料、并发症发生情况、临床监测指标及围生结局进行统计学分析比较.结果 早发组与晚发组间并发症发生率差异无显著性意义（P＞0.05）,有无产前检查和血压波动变异情况、眼底血管改变是发生子痫、胎盘早剥、HELLP综合征及高血压脑病、心衰肺水肿的危险因素;终止妊娠时孕周越高,围生儿预后越好.结论 保守治疗可以改善重度子痫前期患者围生结局预后,注重各种并发症的临床监控是早发型重度子痫前期保守治疗的关键,终止妊娠时的孕龄是影响围生结局的主要因素.     

早发型重度子癎前期的临床特点和治疗探讨

目的探讨早发型重度子癎前期的临床特点及治疗。方法对温州医学院附属第一医院妇产科2002-01-2004-12收治的179例重度子癎前期患者(其中早发型43例,即24~34孕周发病者;晚发型136例,即≥34孕周发病者)及其新生儿210例进行回顾性分析,观察指标包括一般情况、并发症/合并症及母婴结局。结果早发型重度子癎前期患者分娩孕周较晚发型早(P<0·01)、治疗时间较晚发型长(P<0·05),其临床症状及并发症/合并症较晚发型严重,母婴结局明显较晚发型差。结论早发型重度子癎前期病情严重,围生儿预后不佳,应根据母胎情况,严格选择病例进行保守治疗,同时密切监测母胎病情变化。     

早发型重度子痫前期妊娠结局分析

目的:探讨早发型重度子痫前期的临床特点及围生结局。方法:回顾性分析2006年6月至2009年6月四川大学华西第二医院收治的重度子痫前期患者413例,以发病孕周34周为界限,分为早发型重度子痫前期组156例(早发型组)及晚发型重度子痫前期组257例(晚发型组)。比较两组一般情况、并发症、分娩方式及围生儿结局等指标。结果:早发型组患者在终止妊娠孕周、延长孕周时间、住院时间、入院时血压、24小时尿蛋白、并发症发生率及围生儿结局等方面与晚发型组比较,差异均有高度统计学意义(P<0.01)。结论:早发型重度子痫前期患者病情严重,围生儿预后不佳,应根据母胎情况,适时剖宫产终止妊娠。     

重度子痼前期终止妊娠的时机方式与结局

目前治疗子痢前期（PE）唯一有效的方法是终止妊娠。对晚发型重度子痢前期，胎儿已经基本成熟或接近成熟，常毫不犹豫的终止妊娠。但对于早发型重度子痫前期，如何处理却是临床产科医师面临的难题。过多延长孕周将导致母亲严重并发症，而过早终止妊娠却又因胎儿不成熟而使新生儿并发症和死亡率大大增加。而且这些妇女再次怀孕发生早发型重度子痫前期的机率更高，其围生儿结局依然很差。因此。应选择适宜的分娩孕周，在保证母亲安全的同时获得健康存活的婴儿。     

早发型重度子痫前期期待治疗及妊娠结局

目的：探讨早发型重度子痫前期期待治疗和终止妊娠时机选择对母儿结局的影响。方法：对72例早发型重度子痫前期病例进行回顾性分析,按终止妊娠的孕周分3组,比较母儿结局。结果：随期待治疗时间的延长,新生儿窒息率和死亡率明显下降（P〈0．01）,而孕妇并发症无明显增加。结论：对早发型重度子痫前期,期待治疗和适时终止妊娠是最大限度降低孕产妇和围产儿死亡率的重要方法。     

重度子癎前期终止妊娠的时机方式与结局

目前治疗子疒间前期(PE)唯一有效的方法是终止妊娠。对晚发型重度子疒间前期,胎儿已经基本成熟或接近成熟,常毫不犹豫的终止妊娠。但对于早发型重度子疒间前期,如何处理却是临床产科医师面临的难题。过多延长孕周将导致母亲严重并发症,而过早终止妊娠却又因胎儿不成熟而使新生儿并发症和死亡率大大增加。而且这些妇女再次怀孕发生早发型重度子疒间前期的机率更高,其围生儿结局依然很差。因此。应选择适宜的分娩孕周,在保证母亲安全的同时获得健康存活的婴儿。1接近足月妊娠重度子疒间前期的处理妊娠36周后的重度子疒间前期患者,控制病情的…     

早发型和晚发型重度子痫前期分娩方式及母婴结局分析

目的探讨早发型和晚发型重度子痫前期分娩方式及母婴结局。方法收集1977-2010年在西安交通大学医学院第一附属医院产科住院的重度子痫前期患者4457例,其中早发型860例,晚发型3597例。回顾性分析其分娩方式及母婴结局。结果早发型和晚发型重度子痫前期剖宫产率分别为57.7%和36.9%,早发型明显高于晚发型(P=0.02);胎盘早剥是最常见并发症,在早发型和晚发型重度子痫前期发生率分别为6.7%和4.6%(P<0.05)。早发型和晚发型重度子痫前期围生儿死亡率分别为3.6%和2.2%(P<0.01)。特别是早发型妊娠34周前终止妊娠者,围生儿死亡率高达4.9%。结论子痫前期终止妊娠的主要方式为剖宫产术;发病孕周越早,母婴不良结局发生率越高。     

早发型重度子痫前期对母儿的影响及围产结局

对早发型重度子痫前期发病孕周、终止妊娠孕周、孕周延长时间、母亲严重并发症发生情况及小于孕龄儿发生情况等进行阐述.认为发病孕周是影响胎儿及新生儿病死率的主要因素,发病孕周早围生儿预后差.在终止妊娠前短期的保守治疗(期待疗法)是安全有效的,能明显降低围生儿死亡率及提高生存率.     

早发型重度子痫前期发病及母婴结局的临床分析

目的:分析不同孕周早发型重度子痫前期发病与母婴结局.方法:对127例早发型重度子痫前期病例进行回顾性分析,根据其孕周不同分为3组,即A组(孕周<28周)、B组(28周≤孕周<32周)、C组(32周≤孕周<34周),比较3组间孕产妇终止妊娠和保守治疗时间,并发症发生情况、围生儿存活情况、母亲死亡情况以及分娩方式.结果:3组间终止妊娠时间比较差异有统计学意义(P<0.05),B组保守治疗时间与A、C两组比较,A组并发症发生率与B、C两组比较差异有统计学意义(P<0.05);3组间围生儿死亡率(胎死宫内及新生儿死亡)比较差异有统计学意义(P<0.05),A组胎儿生长受限和胎儿窘迫发生率与C组比较,B组胎儿生长受限发生率与C组比较差异均有统计学意义(P<0.05);3组孕妇死亡率比较差异无统计学意义.结论:早发型重度子痫前期孕妇常伴有高并发症率和高围生儿死亡率,且孕周越小发生率越高,在保证孕妇安全下可采取保守治疗适当延长胎龄,以期达到胎儿成熟,降低围生儿死亡率,提高新生儿存活率.     

早发型重度子痫前期的临床特点和治疗探讨

目的探讨早发型重度子痢前期的临床特点及治疗。方法对温州医学院附属第一医院妇产科2002-01—2004-12收治的179例重度子痢前期患者（其中旱发型43例，即24～34孕周发病者；晚发型136例，即／〉34孕周发病者）及其新生儿210例进行回顾性分析，观察指标包括一般情况、并发症／合并症及母婴结局。结果早发型重度子痈前期患者分娩孕周较晚发型早（P〈0.01）、治疗时间较晚发型长（P〈0．05），其临床症状及并发症／合并症较晚发型严重，母婴结局明显较晚发型差。结论早发型重度子痈前期病情严重，围生儿预后不佳，应根据母胎情况，严格选择病例进行保守治疗，同时密切监测母胎病情变化。     

Maternal and fetal outcome in valvular heart disease.

OBJECTIVES: To compare the pregnancy outcomes of women having valvular heart disease with the pregnancy outcomes of healthy women. METHODS: A retrospective comparison of the maternal and fetal pregnancy outcomes of 312 women with valvular heart disease and 321 healthy women cared for at a tertiary care hospital during the same period. Statistical analysis was done using the chi(2)-test, with significance fixed at 0.05. RESULTS: Women with valvular heart disease had a significantly higher incidence of surgical interventions during pregnancy than women in the control group [13.4% (balloon mitral valvotomy) vs. 0.6% (ovarian cystectomy)], congestive heart failure (5.1% vs. 0%, P<0.001), and mortality [0.64% (two women) vs. 0%]. Perinatal outcome was also more adverse in the valvular heart disease group than in the control group, with increased preterm delivery rate (48.3% vs. 20.5%), reduced birth weight (2434+/-599 g vs. 2653+/-542 g; P<0.001), and a higher incidence of APGAR scores less than 8 (8.3% vs. 4%; P<0.01). There was also a higher rate of instrumental delivery (9.9% vs. 3.4%). However, the rate of cesarean deliveries was similar in the two groups. CONCLUSIONS: Pregnancy in women with valvular heart disease is associated with significantly higher maternal morbidity and adverse fetal outcomes and requires a team approach for optimal management.     

Male disadvantage for neonatal complications of term infants,especially in small-for-gestational age neonates

Abstract

Objective: Sex differences in long and short-term outcomes for infants are observed. This has also been shown for several neonatal complications in preterm neonates. We aimed to evaluate whether sex impacts neonatal outcome among term neonates. Furthermore, we were interested in whether small-for-gestational age male and female neonates at term presented with different patterns of neonatal complications.

Methods: Data on all term singleton deliveries and respective neonatal outcomes between 2004 and 2008 at a single tertiary medical center were utilized for this retrospective cohort study. Immediate neurological complications were defined as one or more of the following: intraventricular hemorrhage, convulsions, asphyxia and acidosis. Neonatal complications were compared between male and female term infants, as well as male and female term small-for-gestational age (SGA) neonates.

Results: 37?342 singleton neonates were born ≥37 weeks’ gestation. 19?112 neonates were males. Birth weight, cesarean sections and operative deliveries were significantly higher for males. Neonatal hypoglycemia and immediate neurological complications were significantly more frequent in males. For term SGA’s, low 5-min apgar scores (<7) at 39–40 weeks were 2.65 times higher for males compared with females, as was hypoglycemia.

Conclusions: Male infants at term, especially male SGA infants, are more likely to encounter complications during labor and require special neonatal care due to metabolic and/or neurological complications.     

The impact of maternal epilepsy on perinatal outcome in singleton gestations

Objective: We sought to evaluate perinatal outcomes in women with epilepsy.

Methods: We performed a retrospective cohort study between 2007 and 2014, at a tertiary, university-affiliated medical center. All women with singleton gestation who delivered during the study period were included, except for pregnancies in which fetuses with chromosomal or structural anomalies were diagnosed. Perinatal outcome was compared between two groups: women diagnosed with epilepsy and women without epilepsy.

Results: Out of 62,102 deliveries during the study period, 61,455 met the inclusion criteria, of whom 206 (0.3%) had epilepsy. The only difference found in maternal demographics was higher rate of nulliparity in the epilepsy group (p?=?.02). As for maternal adverse outcome, higher rates of placental abruption and longer postpartum admission were found in women with epilepsy (p?=?.02 and p?p?p?=?.02), neonatal intensive care unit (NICU) admissions (OR 1.84, 95%CI 1.25–2.70, p?=?.002), seizures (OR 4.33, 95%CI 1.60–11.77, p?=?.004), transient tachypnea of the newborn (OR 2.47, 95%CI 1.005–6.05, p?=?.049) and respiratory distress syndrome (OR 7.16, 95%CI 2.47–20.76, p?Conclusions: Epilepsy in pregnant women is associated with adverse perinatal outcomes, including neonatal seizures, placental abruption and respiratory problems.     

Small-for-gestational-age fetuses with normal umbilical artery Doppler have suboptimal perinatal and neurodevelopmental outcome

Objective

To evaluate the perinatal and neurodevelopmental outcome of small-for-gestational-age fetuses with normal umbilical artery Doppler managed expectantly during pregnancy and delivery.

Study design

Perinatal and neurodevelopmental outcome was assessed from a cohort of singleton small-for-gestational-age fetuses with normal umbilical artery Doppler and normally grown controls matched by gestational age at delivery, parity and parental socio-economic level. Neurodevelopmental outcome was prospectively evaluated by means of the 24-month Age&Stage Questionnaire (ASQ).

Results

A total of 129 small-for-gestational-age fetuses and 259 controls were included. Small-for-gestational-age fetuses had a higher risk for neonatal intensive care unit admission (15.5% versus 3.9%; p < 0.001) and significant neonatal morbidity (2.3% versus 0%; p = 0.04) than controls. At 24-months, these fetuses showed significantly lower neurodevelopmental centile in the problem solving (42.8 versus 52.1; p = 0.001) and personal-social (44.4 versus 54.6; p < 0.001) areas than controls.

Conclusion

Perinatal and neurodevelopmental outcome in small-for-gestational-age fetuses with normal umbilical artery Doppler is suboptimal, which may challenge the role of umbilical artery Doppler to discriminate between normal-SGA and growth-restricted fetuses.     

Predictors of poor obstetric outcome in women with systemic lupus erythematosus: a 10-year experience of a university hospital

Objective: To compare the maternal and fetal outcome in patients with systemic lupus erythematosus (SLE) by a retrospective analysis from 2005 to 2010, and a prospective follow-up of pregnant SLE patients from 2010 to 2015 to find out predictors of poor obstetric outcome.

Methods: The study included 236 SLE pregnant females (retrospective group) whose data were viewed retrospectively from their medical records, and 214 SLE pregnant females (prospective group) who were followed prospectively to record their maternal and fetal outcome.

Results: There was a highly significant difference between the two groups regarding abortion, venous thromboembolism, prematurity, and intrauterine fetal death (p?p?p?Conclusion: Improved maternal and fetal outcome in women with SLE has occurred following integrated multidisciplinary approach. This emphasizes the importance of postponing pregnancy when predictors of poor outcome are encountered.     

Intrapartum fever and the risk for perinatal complications – the effect of fever duration and positive cultures

Objective: To estimate the association between intrapartum fever and adverse perinatal outcome.

Methods: A retrospective cohort study of women attempting vaginal delivery at term in a tertiary hospital (2012–2015). Perinatal outcome of deliveries complicated by intrapartum fever (≥38.0?°C) were compared to women with no intrapartum fever matched by parity and gestational age at delivery in a 1:2 ratio. Maternal outcome included cesarean section (CS), operative vaginal delivery (OVD), retained placenta or post-partum hemorrhage. Neonatal outcome included 5-minute Apgar score <7, umbilical artery pH <7.1, meconium aspiration syndrome, need for mechanical ventilation or hypoxic ischemic encephalopathy.

Results: Overall, 309 women had intrapartum fever and 618 served as controls. Women with intrapartum fever had higher rates of OVD (34.3 versus 19.6%, p?p?p?p?p?=?.01).

Conclusions: Intrapartum fever was associated with adverse perinatal complications. The duration of intrapartum fever, maternal bacteremia, and positive cultures further increase this risk.     

Improved pregnancy outcome following earlier splenectomy in women with immune thrombocytopenia: a 5-year observational study

Objective: To assess prospectively the maternal and fetal outcome in women with immune thrombocytopenic purpura (ITP) who undergone earlier splenectomy compared to women on medical therapy.

Methods: A 5-year observational study included pregnant women in the first trimester previously diagnosed with primary ITP with 74 patients underwent splenectomy before pregnancy and 86 patients on medical therapy. Patients were followed throughout pregnancy and labour to record their obstetric outcome. Data were collected and tabulated.

Results: There was a higher platelet count in the splenectomy group at enrollment (p?p?p?p?p?p?p?p?p?Conclusion: Earlier splenectomy in patients with ITP may have a beneficial impact on obstetric outcome and should be explained to patients wishing to get pregnant. Further larger multicenter studies are warranted to confirm or refute our findings.     

Prevalence of Overt and Subclinical Thyroid Dysfunction Among Pregnant Women and Its Effect on Maternal and Fetal Outcome

Aim

To determine the current prevalence of thyroid dysfunction in normal pregnant women and to study the impact of thyroid dysfunction on maternal and fetal outcome.

Methods

400 pregnant women between 13 and 26 weeks of gestation were registered for the study. Apart from routine obstetrical investigations, TSH tests were done. Free T4 and anti-TPO antibody tests were done in patients with deranged TSH. Patients were followed up till delivery. Their obstetrical and perinatal outcomes were noted.

Results

The prevalence of hypothyroidism and hyperthyroidism was 12 and 1.25 %, respectively. Adverse maternal effects in overt hypothyroidism included preeclampsia (16.6 vs. 7.8 %) and placental abruption (16.6 vs. 0.8 %). Subclinical hypothyroidism was associated with preeclampsia (22.3 vs. 7.8 %) as compared to the euthyroid patients. Adverse fetal outcomes in overt hypothyroidism included spontaneous abortion (16.6 vs. 2.39 %), preterm birth (33.3 vs. 5.8 %), low birth weight (50 vs. 12.11 %), intrauterine growth retardation (25 vs. 4.9 %), and fetal death (16.6 vs. 1.7 %) as compared to the euthyroid women. Adverse fetal outcomes in subclinical hypothyroidism included spontaneous abortion (5.5 vs. 2.39 %), preterm delivery (11.2 vs. 5.8 %), low birth weight (25 vs. 12.11 %), and intrauterine growth retardation (8.4 vs. 4.9 %) as compared to the euthyroid women.

Conclusions

The prevalence of thyroid disorders was high in our study with associated adverse maternal and fetal outcomes. Routine screening of thyroid dysfunction is recommended to prevent adverse fetal and maternal outcome.